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NDT Advance Access published online on August 18, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl424
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received December 8, 2005
Accepted June 20, 2006

Original Article

Impact of a quality improvement programme based on vascular access flow monitoring on costs, access occlusion and access failure

Edwin Wijnen 1, Nils Planken 2, Xavier Keuter 2, Jeroen P. Kooman 1, Jan H. M. Tordoir 2, Michiel W. de Haan 3, Karel M. L. Leunissen 1, and Frank van der Sande 1 *

1 Department of Internal Medicine and Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
2 Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands
3 Department of Radiology, University Hospital Maastricht, Maastricht, The Netherlands

* To whom correspondence should be addressed.
Frank van der Sande, E-mail: fvs{at}groupwise.azm.nl



  Abstract

Background. Vascular access thrombosis is a substantial source of morbidity in chronic haemodialysis patients. Periodical access flow measurements can predict the presence of vascular access stenosis and provide an opportunity for early intervention to prevent subsequent vascular access thrombosis. By this system of quality improvement, vascular access-related costs might be reduced. The aim of this study was to analyse the cost impact of a quality improvement programme based on periodic access flow measurements.

Methods. The number and costs of vascular access interventions (summary of angiography, percutaneous transluminal angioplasty, catheter placement, hospitalization days and costs for surgery) in the period 2001-2003 (quality improvement period; QIP, 218.6 patient-years observed) were retrospectively compared with a reference period (RP, 1996-1998, 214.4 patient-years observed) during which no access flow was measured. All access flow measurements were done on a regular base and interventions were performed according to the Kidney Disease Outcome Quality Initiative.

Results. Surgical thrombectomy procedures were significantly less during the QIP (0.25 ± 0.57 events/patient-year) compared with RP (0.63 ± 1.06 events/patient-year; P = 0.000), whereas access loss was not significantly different. During the QIP, 205 radiological interventions were performed (0.88 ± 1.16 events/patient-year), and in the RP around 48 (0.33 ± 0.65 events/patient-year; P = 0.000). Access-related costs tended to be lower during the QIP compared with the RP. The cost reduction appeared to be limited to patients with arteriovenous graft (AVG), in which access-related costs were significantly lower during the QIP ({euro}2360.95 ± 2838.17 patient-year) compared with the RP ({euro}4003.96 ± 3810.92 patient-year; P = 0.012), but not in patients with arteriovenous fistula (AVF).

Conclusion. A quality improvement programme based on periodical access flow measurement reduced the number of acute vascular access failures due to thrombotic events and also significantly reduced health care costs in patients with AVG, but not in patients with AVF. The quality improvement programme had no effect on access survival.


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